Abstract
Many of the children with sickle cell disease born in sub-Saharan Africa remain undiagnosed and untreated. Increasing capacity and infrastructure to support diagnostic and screening programs in high income countries have enabled near universal survival into adulthood. Early diagnosis and treatment are achievable goals that enjoy widespread consensus in sub-Saharan Africa but may require a variety of individualized approaches that are specific to each country. A clear understanding of the issues that influence program building is required before identifying solutions adapted to the diverse health care settings in Africa and responsive to the challenges observed during pilot programs.